Impact of prior robotic surgical expertise on the results of Hugo RAS radical prostatectomy: a propensity score-matched comparison between Da Vinci-expert and non-Da Vinci-expert surgeons

摘要

BACKGROUND: Hugo RAS is a novel robotic platform gaining global adoption. Most reported outcomes come from centers with prior Da Vinci experience, with limited data from robotic-naïve settings or comparisons based on prior robotic expertise. OBJECTIVE: To compare outcomes of Hugo RAS robot-assisted radical prostatectomy (RARP) performed by Da Vinci-experienced (DVE) versus non-Da Vinci-experienced (NDVE) surgeons. DESIGN, SETTING, AND PARTICIPANTS: Prospective data from patients undergoing Hugo-RARP (July 2022-November 2024) were analyzed. Patients were grouped based on whether their surgeon had prior Da Vinci experience. None had prior Hugo-RAS experience. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Primary outcomes were positive surgical margin (PSM) and complication rates. Secondary outcomes included operative time (OT), estimated blood loss (EBL), length of stay (LOS), continence, and potency. Propensity score matching adjusted for baseline differences. RESULTS AND LIMITATIONS: After matching, 117 patients per group were analyzed. PSM rates (17% vs. 21%; p = 0.40) and complications (p = 0.63) were similar. DVE surgeons had shorter OT (179 vs. 206 min; p < 0.001) and lower EBL (127 vs. 161 ml; p = 0.008). LOS did not differ (p = 0.84), and 12-month functional and oncological outcomes were comparable. Limitations include the non-randomized, single-center design. CONCLUSIONS: Hugo RAS enables safe and effective RARP with comparable outcomes regardless of prior robotic experience. Prior Da Vinci experience, however, improves intraoperative efficiency.